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Hospital Biller

Job ID 146509 Date posted 06/06/2018

Position Summary:
Responsible for clean and timely submissions of 837I and UB claims to insurance carriers to ensure maximum reimbursement for the Hospital Health System.

Essential Duties & Responsibilities including but not limited to:
1) Responsible for the timely submission of clean 837I and/or UB claims.
2) Follows up on 277CA rejections within assigned WQ?s until acceptance validation has been received by the payer.
3) Interacts by telephone and/or mail with payers relative to claims processing.
4) Resubmits claims when necessary, utilizing a variety of EDI technologies and relevant billing systems to reduce aged rejections.
5) Reviews, validates, and updates coverage changes on hospital accounts within assigned WQ to avoid denials (i.e. COB, invalid payer, etc)
6) Resolves accounts within Hospital Billing Claim Edit WQ?s due to invalid account information(i.e., wrong subscriber ID format, patient demographics, etc)
7) Sorts, prepares and processes incoming and outgoing paper UB and insurance correspondence.
8) Maintains detailed documentation on individual account activity such as correspondence, phone conversations, and the like.
9) Resolves specific payer/plan claim edits in assigned WQ?s generated from within Epic and the external Clearinghouse Vendor.
10) Establishes relationships and maintains open communication with third party payor representatives in order to resolve claims issues.
11) Identifies internal and/or external billing issues and notifies Supervisor and/or Manager.
12) Alerts Supervisor and/or Manager to procedural and/or system changes based upon payer billing requirements
13) Accessing payer websites for eligibility, claim status, possible online corrections, and viewing both the most current EDI and paper billing regulations.

Organizational Requirements:
Maintain strict adherence to the Lahey Health Confidentiality policy.
Incorporate Lahey Health Standards of Behavior and Guiding Principles into daily activities.
Comply with all Lahey Health Policies.
Comply with behavioral expectations of the department and Lahey Health.
Maintain courteous and effective interactions with colleagues and patients.
Demonstrate an understanding of the job description, performance expectations, and competency assessment.
Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
Participate in departmental and/or interdepartmental quality improvement activities.
Participate in and successfully completes Mandatory Education.
Perform all other duties as needed or directed to meet the needs of the department.


Minimum Qualifications:

Education: High School Diploma or equivalent.

Licensure, Certification & Registration: None

Experience: Minimum 1 year experience in hospital billing and/or related activities.



About Lahey Health

The Lahey Model of Care - right care, right time, right place - is exactly what patients, providers and payers need and deserve. Identifying and delivering on this convergence of interests has positioned Lahey Health for further growth. Our model ensures care is highly coordinated and locally delivered, with lower costs and exceptional quality.

Lahey Health is a robust, regional system including a teaching hospital, community hospitals, primary care providers, specialists, behavioral and home health services, skilled nursing and rehabilitation facilities, and senior care resources throughout northeastern Massachusetts and southern New Hampshire. The system has a global presence with programs in Canada, Jordan and Bermuda.

How To Apply

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